Julie R Gaither1, Kirsha Gordon2, Stephen Crystal3, E Jennifer Edelman4, Robert D Kerns5, Amy C Justice6, David A Fiellin7, William C Becker8. 1. Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT; Yale School of Public Health, Yale University, New Haven, CT; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT; Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, CT. Electronic address: julie.gaither@yale.edu. 2. VA Connecticut Healthcare System, West Haven, CT. 3. Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ. 4. Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT; Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT. 5. Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT. 6. VA Connecticut Healthcare System, West Haven, CT; Yale School of Public Health, Yale University, New Haven, CT; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT; Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT. 7. Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, CT; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT; Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT. 8. VA Connecticut Healthcare System, West Haven, CT; Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT.
Abstract
BACKGROUND: Among patients prescribed long-term opioid therapy (LTOT) for chronic pain, no study has yet examined how clinicians respond to evidence of illicit drug use and whether the decision to discontinue opioids is influenced by a patient's race. METHODS: Among outpatients of black and white race initiating LTOT through the VA between 2000 and 2010, we reviewed electronic medical records to determine whether opioids were discontinued within 60 days of a positive urine drug test. Logistic regression was used to examine differences by race. RESULTS: Among 15,366 patients of black (48.1%) or white (51.9%) race initiating LTOT from 2000 to 2010, 20.5% (25.5% of blacks vs. 15.8% of whites, P <. 001) received a urine drug test within the first 6 months of treatment; 13.8% tested positive for cannabis and 17.4% for cocaine. LTOT was discontinued in 11.4% of patients who tested positive for cannabis and in 13.1% of those who tested positive for cocaine. Among patients testing positive for cannabis, blacks were 2.1 times more likely than whites to have LTOT discontinued (adjusted odds ratio [AOR] 2.06, 95% confidence interval [CI] 1.04-4.08). Among patients testing positive for cocaine, blacks were 3.3 times more likely than whites to have LTOT discontinued (AOR 3.30, CI 1.28-8.53). CONCLUSIONS: Among patients testing positive for illicit drug use while receiving LTOT, clinicians are substantially more likely to discontinue opioids when the patient is black. A more universal approach to administering and responding to urine drug testing is urgently needed.
BACKGROUND: Among patients prescribed long-term opioid therapy (LTOT) for chronic pain, no study has yet examined how clinicians respond to evidence of illicit drug use and whether the decision to discontinue opioids is influenced by a patient's race. METHODS: Among outpatients of black and white race initiating LTOT through the VA between 2000 and 2010, we reviewed electronic medical records to determine whether opioids were discontinued within 60 days of a positive urine drug test. Logistic regression was used to examine differences by race. RESULTS: Among 15,366 patients of black (48.1%) or white (51.9%) race initiating LTOT from 2000 to 2010, 20.5% (25.5% of blacks vs. 15.8% of whites, P <. 001) received a urine drug test within the first 6 months of treatment; 13.8% tested positive for cannabis and 17.4% for cocaine. LTOT was discontinued in 11.4% of patients who tested positive for cannabis and in 13.1% of those who tested positive for cocaine. Among patients testing positive for cannabis, blacks were 2.1 times more likely than whites to have LTOT discontinued (adjusted odds ratio [AOR] 2.06, 95% confidence interval [CI] 1.04-4.08). Among patients testing positive for cocaine, blacks were 3.3 times more likely than whites to have LTOT discontinued (AOR 3.30, CI 1.28-8.53). CONCLUSIONS: Among patients testing positive for illicit drug use while receiving LTOT, clinicians are substantially more likely to discontinue opioids when the patient is black. A more universal approach to administering and responding to urine drug testing is urgently needed.
Authors: Julie R Gaither; Joseph L Goulet; William C Becker; Stephen Crystal; E Jennifer Edelman; Kirsha Gordon; Robert D Kerns; David Rimland; Melissa Skanderson; Daniel F Weisberg; Amy C Justice; David A Fiellin Journal: J Pain Date: 2014-08-23 Impact factor: 5.820
Authors: Erick G Guerrero; Jeanne C Marsh; Lei Duan; Christine Oh; Brian Perron; Benedict Lee Journal: Health Serv Res Date: 2013-01-27 Impact factor: 3.402
Authors: Amy C Justice; K A McGinnis; M Skanderson; C C Chang; C L Gibert; M B Goetz; D Rimland; M C Rodriguez-Barradas; K K Oursler; S T Brown; R S Braithwaite; M May; K E Covinsky; M S Roberts; S L Fultz; K J Bryant Journal: HIV Med Date: 2009-09-14 Impact factor: 3.180
Authors: Amy C Justice; Sharada P Modur; Janet P Tate; Keri N Althoff; Lisa P Jacobson; Kelly A Gebo; Mari M Kitahata; Michael A Horberg; John T Brooks; Kate Buchacz; Sean B Rourke; Anita Rachlis; Sonia Napravnik; Joseph Eron; James H Willig; Richard Moore; Gregory D Kirk; Ronald Bosch; Benigno Rodriguez; Robert S Hogg; Jennifer Thorne; James J Goedert; Marina Klein; John Gill; Steven Deeks; Timothy R Sterling; Kathryn Anastos; Stephen J Gange Journal: J Acquir Immune Defic Syndr Date: 2013-02-01 Impact factor: 3.731
Authors: Pooja A Lagisetty; Lewei A Lin; Dara Ganoczy; Rebecca L Haffajee; Theodore J Iwashyna; Amy S B Bohnert Journal: Med Care Date: 2019-10 Impact factor: 2.983
Authors: Joshua J Fenton; Alicia L Agnoli; Guibo Xing; Lillian Hang; Aylin E Altan; Daniel J Tancredi; Anthony Jerant; Elizabeth Magnan Journal: JAMA Netw Open Date: 2019-11-01
Authors: Joseph W Frank; Evan Carey; Charlotte Nolan; Anne Hale; Sean Nugent; Erin E Krebs Journal: J Gen Intern Med Date: 2020-11-03 Impact factor: 5.128